Drug interactions are a common cause of iatrogenic disease in geriatric patients. Computer programs now exist which allow one to analyse groups of drugs for potential interactions. In an audit of charts of 100 geriatric patients seen in the Family Practice Center at Barberton Citizens Hospital, a computer printout was obtained, listing all patients aged 60 years and over who were seen at the Center during 1989. Names were selected randomly from this list by the head nurse and their charts were obtained for review, generating information on patient identification number, age, sex, diagnoses, medications, and allergies. The medications were analysed using the Hansten Drug Interaction Knowledge Base Program, which identified 27 patients as being on a combination of medications which had one or more potential drug interactions. A total of 37 potential drug interactions were identified in this group of 27 patients. Relative risk ratios were determined using the computer program, 'Epi Info,' for sex (female versus male), age (greater than or equal to 75 vs. 60-75 years), number of diagnoses greater than or equal to 3 vs. 0-2), and number of medications (greater than or equal to 4 vs. 0-3). The five medications, or groups of medications, which were most likely to be involved in potential drug interactions were digoxin, beta-blockers, oestrogen, oral hypoglycaemic agents, and diuretics.
An elderly patient who falls is at significant risk for disability or death. In this article, Dr Costa explains how a carefully taken history, detailed physical examination, and appropriate laboratory studies can help to discern the cause of a fall. He also describes a multifaceted approach to preventing falls in elderly patients that involves a partnership of the physician, the patient, and the family.
Invertebrate model systems, such as nematodes and fruit flies, have provided valuable information about the genetics and cellular biology involved in aging. However, limitations of these simple, genetically tractable organisms suggest the need for other model systems, some of them invertebrate, to facilitate further advances in the understanding of mechanisms of aging and longevity in mammals, including humans. This paper introduces 10 review articles about the use of invertebrate model systems for the study of aging by authors who participated in an 'NIA-NIH symposium on aging in invertebrate model systems' at the 2013 International Congress for Invertebrate Reproduction and Development. In contrast to the highly derived characteristics of nematodes and fruit flies as members of the superphylum Ecdysozoa, cnidarians, such as Hydra, are more 'basal' organisms that have a greater number of genetic orthologs in common with humans. Moreover, some other new model systems, such as the urochordate Botryllus schlosseri, the tunicate Ciona, and the sea urchins (Echinodermata) are members of the Deuterostomia, the same superphylum that includes all vertebrates, and thus have mechanisms that are likely to be more closely related to those occurring in humans. Additional characteristics of these new model systems, such as the recent development of new molecular and genetic tools and a more similar pattern to humans of regeneration and stem cell function suggest that these new model systems may have unique advantages for the study of mechanisms of aging and longevity.Aging and longevity studies in invertebrate model systems, especially the round worm (Caenorhabditis elegans) and the fruit fly (Drosophila melanogaster), have yielded many insights into the understanding of the genetics and biology of lifespan and healthspan. These two short-lived invertebrate organisms, the fruit fly D. melanogaster and the nematode C. elegans, along with studies in single-celled organisms like the yeast, Saccharomyces cerevisiae, demonstrated the usefulness of genetically tractable model systems for uncovering the complexities of the aging process.
With the pathophysiology of anaphylaxis firmly in mind, the primary care physician can accurately diagnose and effectively treat this acute, life-threatening condition. The necessary drugs and equipment must be present in the office of any physician who performs skin testing, administers immunotherapy or intramuscular antibiotics, or uses local anesthetics. The drug of choice, epinephrine, must be administered as soon as the diagnosis is made, and hospitalization is necessary to guard against recurrent anaphylaxis. Preventive measures, including identification of the offending antigen, avoidance instructions, epinephrine for self-administration, and immunotherapy should be considered for all patients.
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